THE ROLE OF THE PRECEPTOR IN MINIMIZING HORIZONTAL VIOLENCE

Many newly hired nurses experience horizontal violence, sometimes called bullying, that may push them away from a particular organization or even from the profession. On the reverse side, most nurses stay in their position because they have bonded with the work team. A key aspect of the preceptor role must be to welcome and draw the newly hired nurse into the team and to minimize any horizontal violence or bullying that might be pushing them away. The following strategies may help the preceptor address these issues and would be appropriate to include in a preceptor education program.

Preceptor strategies for welcoming the new nurse are as follows:

1. Arrange to meet the new hire at a central location before the first work shift and escort him or her onto the nursing unit. Arrange to meet the new hire early enough before the shift so that you will not have to rush to shift report.

2. Find out a little bit about the new hire and tell him or her a little about yourself.

3. Explain your role in helping the new hire integrate into the unit and to help add to his or her current knowledge and skills to ensure success in the new role. Find out what he or she believes are current learning needs and if there is something he or she is particularly worried about. Set a plan for the day that addresses these learning needs and the needs of the unit. Provide frequent feedback with the intent of helping the new nurse develop the skills needed on the unit.

4. Introduce the new hire to the nursing, medical, and ancillary staff, describing how to contact these people and how you access them in your daily practice (e.g., "Jim is really great with patients with renal problems, so whenever I have a question about a renal problem, I ask Jim.")

5. Remind the newly hired nurse that you expect him or her to have many questions and that you will be glad to help answer them or direct him or her to the best resource to address the concern.

6. Ask the new nurse to let you know how the orientation is going from his or her perspective.

Preceptor strategies for minimizing horizontal violence are as follows:

1. Be alert to behaviors that indicate that horizontal violence or bullying is going on. In nursing, these are usually subtle behaviors that we may be passing off, saying "Oh, that's just the way she or he is." Behaviors can include making deep sighs, eye rolling, sneering, ignoring questions or concerns, not offering to help when help is needed, talking behind someone's back, undermining, withholding needed information, and scapegoating (Griffin, 2004). Although horizontal violence can come from any member of the care team, nurses report that nurse-to-nurse violence is the most distressing form of horizontal violence (Farrell, 1999).

2. Be aware that the newly hired nurse, especially if the new hire is a new graduate, is in a vulnerable position. From this vulnerable position, behaviors you might have learned to live with or not take personally can feel devastating. When you think about it, maybe you should not have to live with these behaviors either. According to the American Association of Critical Care Nurses (n.d.), these very behaviors can get in the way of safe patient care.

3. Be aware of your own behavior. Any of us can be short or appear unwelcoming when we are frustrated and tired (Hutton, 2006). Ask forgiveness and explain your behavior if necessary.

4. Model professional behaviors such as accepting your fair share of the work, offering help, listening carefully to others' concerns and answering questions, keeping confidences, standing up for the absent member in a conversation, and refraining from criticizing others publicly (Griffin, 2004).

5. If someone's behavior looks like bullying or incivility, point out the behavior to the individual in a way that makes the point that the behavior is not welcome yet in a way that is respectful to all involved. If the behavior is nonverbal, you might try commenting on the behavior and asking for clarification. For example, "It's really important to me that this new nurse do well here and I think you're the best person to help him with understanding managing insulin drips, but when he asked you a question just now, I noticed that you rolled your eyes and didn't answer. Help me understand what that means," or, "If that were me, seeing you roll your eyes might have put me off from asking you questions and that may get in the way of this new person's learning what she needs to in order to give the best care to patients," or, "This seems to be a bad time; when might be a good time to ask you about this?" Try rehearsing some responses in advance. Listen to how they sound. Does your response make the point that the behavior is not welcome while sounding respectful and not escalating the behavior? Griffin's (2004) work on cognitive rehearsal might give you some more ideas.

6. Help the new hire learn how to speak up using the formula in No. 5 above.

7. Talk to the manager, unit educator, or hospital educator about your concerns and enlist their help in dealing with them.

8. Talk with other members of the team to explore if others sense your concerns then talk with the manager about how you can work together to develop a healthier work environment for all.

The preceptor role in welcoming and supporting the newly hired nurse is crucial for the nurse's survival on the unit. Practical tips on how to welcome individuals and frank discussions about and strategies to minimize horizontal violence would be appropriate topics for new and advanced preceptor updates. The following resources may help you craft content for these programs.

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